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Monitoring drug use, health problems and responses in prison population in Europe Dagmar Hedrich, Linda Montanari, Alessandra Bo, Bruno Guarita, Chloé Carpentier, Isabelle Giraudon, Luis Royuela, Lucas Wiessing « Good prison health – Better Public health – Safer Society » Oslo – 24 November 2009 EMCDDA (European Monitoring Centre for Drug and Drug Addiction) • A decentralised agency of the European Union, established in Lisbon 1995 with about 100 staff • Mission: to collect, analyse and disseminate objective, reliable and comparable information on drugs and drug addiction and their consequences • To promote exchange of best practice • Audience: policy makers, scientists and researchers, practitioners and the general public • Based on a network of national institutions (30 countries) The REITOX Network Austrian Health Institute Scientific Institute Public Health Institute for Therapy Research University Mental Health Research Institute Min. of Health Drug Control Department Direction de la Santé Nat. Bureau for Drug Prevention Nat. Monitoring Centre for Drugs and Drug Addiction Estonian Drug Monitoring Centre National Commission for Dependencies Secretariat Nat. Drug Commission Min. of Health Nat. Centre for Epidemiology Trimbos Institute Portuguese Institute Institute Public Health for Drugs & Drug Addiction National Board of Health Board of Ministers for Drug Dependencies and Drug Control French Observatory for Drugs & Drug Addiction State Centre Prevention & Rehabilitation Activities for Drug abuse Prevention Coordination Unit Health Research Board SIRUS National R&D Centre for Welfare & Health National Centre for Addictions European Commission Government Deleg. National Institute to the National Plan of Public Health on Drugs Dept Min. of Health National AntiDrugs Agency Prison Population Rate in the European countries (27 MS + Hr, Tk) SE Below 100 per 100.000 pop FI NO Between 100-150 per 100.000 population EE LV Between 151-200 per 100.000 population DK LT IE More than 201 per 100.000 population UK UK PL NL BE DE BE FR CZ SK AT HU RO SI HR BG LU PT IT TR ES Source: Council of Europe Annual Penal Statistics (SPACE I) 2006 Population demographic data: EUROSTAT EL MT CY Prison Population Rate in the EU27 by country (*100 000 population) Prison population rate 350,00 300,00 250,00 200,00 150,00 120 100,00 50,00 0,00 SI IT DK FI IE CY SE MT HR GR FR TR BE DE AT EU PT NL Source: Council of Europe Annual Penal Statistics (SPACE I) 2006 Population demographic data: EUROSTAT UK ES HU BG SK LU RO CZ PL LT LV EE Drugs as a major factor in imprisonment in EU • Most EU countries: 10-30% of all sentenced inmates convicted for drug offences (SPACE, 2006) • Drug offences represent the main reason for entering prison • Plus property crime (robbery, burglary, etc.) to support a drug addiction • Considerable differences between detention centres and between countries • Countries with highest rates of drug offenders are the drug entry or transit countries Drug use in prison population (some studies since 2002) • Before prison: • Half of those surveyed in prison were regular drug users • Over a third have injected drugs • Current drug use (LYP-LMP): 10-48% males and 30-60% females (Fazel et al. literature review) • Within prison: • 1% to 50% have used drugs • Up to 12% reported a daily use in the last month (one study) • 1%-31% have injected a drug at least once (selected samples) Source: EMCDDA Annual Report 2008, Statistical Bulletin Patients entering drug treatment in prison in 2007 in 5 countries (Ge, Fr, Cy, Sk, Sw) • 3274 drug clients (22% new) (from 95 Cy to 625 in Fr) • 91% males (from 87% in Sk to 99% in Cy) • Mean age: 32 y. males and 34 y. females • Primary drug (relevant differences between countries): • 28% opioids; 24% stimulants; 17% cannabis; 7% cocaine; 24% other drugs • More females (35%) than males (28%) opioid users • 36% injectors of primary drug among patients entering treatment in prison (similar to patients outside prison) HIV prevalence in IDUs in prisons and among IDUs outside prison Country Year of study Sample size % positive Belgium – Flemish Community 1999 316 0.3% 0.5% - 1.9% (186 – 623) Belgium - French Community 2001 573 1.1% 3.4% (267) Bulgaria 2006 613 0.0% 0.8% (487), Sofia Czech Republic 2002 674 0.4% 0.1% (3100) Germany – Berlin 2000 152 18.0% 3.2% (2350) Ireland 1999 173 5.8% 3.5% (509), 1998 Spain 2006 1194 39.7% 36.4% (9068) Luxembourg 1998 116 4.3% 3.5% (142) Malta 2004 58 0.0% 1.3% (77) Finland 2007 1363 0.1% 0.2% (1486), 2006 UK – E&W, ever IDUs 1998 775 0.5% 0.9% (3366) Croatia 2007 200 0.0% 0.0% (128), Zagreb Source: EMCDDA Annual Report 2009, Statistical Bulletin Prevalence in IDUs outside prison (n) HCV antibody prevalence in IDUs in prisons and among IDUs outside prison Country Year of study Sample size % positive Belgium – Flemish Community 1999 321 17.4% 37.9% (195) Belgium – French Community 2001 603 27.7% - Bulgaria 2006 614 17.9% 52.4% (487), Sofia Czech Republic 2002 1319 52.0% 29.9% (686) Germany – Berlin 2000 154 82.5% - Ireland 1999 173 71.7% 72.3% (65), Dublin 2003 Greece 1999 130 63.1% 51.7% (286) Italy - Brescia-Mombello Monza Milano-Opera 1999 165 64.2% - Luxembourg 2005 108 90.7% 81.3% (268) Malta 2004 58 50.0% 34.4% (180) Finland 1999 134 52.0% 38.4% (146) Sweden - Gothenburg 2007 56 32.1% - UK – Scotland, mainly Glasgow 1999 84 42.0% 46.9% (348) UK – E&W, ever IDUs 1998 805 29.8% 41.0% Croatia 2007 200 44% Source: EMCDDA Annual Report 2009, Statistical Bulletin Prevalence in IDUs outside prison (n) (3366) - HBV antibody (aHBc) prevalence in IDUs in prisons and among IDUs outside prison Country Year of study Sample size % positive Prevalence in IDUs outside prison (n) Germany – Berlin 2000 151 53.0% - Ireland 1999 173 17.9% - Greece 1999 130 52.3% 29.1% (1013), 2006 Luxembourg 2005 103 35.9% 24.7% (239) Sweden 1997 184 57.6% - UK – England & Wales (ever IDUs) 1998 805 19.9% 22.0% (3363) Croatia 2007 200 24.0% - Source: EMCDDA Annual Report 2009, Statistical Bulletin Mortality among prisoners and drug related deaths after release from prison • Poor health of prisoners, especially drug users, and higher mortality rates compared to general population • High drug-related post-release mortality rates compared to general population • Standardised mortality ratio (SMR) comparing drug related deaths of released prisoners with a reference population • England and Wales (Farrel et al., 2007): 29 males and 69 females (one week after release) • Denmark (Christensen at al., 2006): 29 (males and females; first two weeks after release) • France (Verger at al., 2003): 124 males 15-34 years and 274 males 35-54 years (first year after release) EU policy framework on drugs and prison I. Council Recommendation of 2003 on prevention and reduction of health-related harm II. EU-Drugs Strategy 2005 – 2012: • EU-AP 2009-2012: Objective 9: “provide access to health care for drug users in prison” • (21) develop services for drug users in prison equivalent to services outside prison in order to reduce drug related health problems; particular attention to period after prison release • (22) implement indicators to monitor drug use, health problems, service delivery Services provided to prisoners in European countries • • • • • • Information on drugs and health Screening for infectious diseases and vaccination Detoxification Substitution treatment Drug-free treatment approaches Preparation for release • Relevant differences between countries and detention centres in level of provision Availability of substitution treatment in the prison system (2006 data) Substitution/maintenance is not available in prisons Exists in just a few prisons LU FI SE Exists in more than a few prisons but not in a majority of them NO EE Exists in a majority of prisons (but not in nearly all of them) LV DK* Exists in nearly all prisons UK IE LT PL NL BE DE CZ SK HU AT FR SI HR* RO IT PT BG ES EL TR CY MT (Source: Expert Rating; Reitox National Focal Points, 2008) Provision of substitution/maintenance treatment (OST) in the community and availability of OST programmes in the prison system in 2007 (expert rating) Level of provision of selected health responses to prisoners in 28 European countries (n. countries) Individual counselling on infection risk Pre-release counselling on 0 2 overdose risk Prison needle and syringe 0 2 exchange programmes 0 Full Extensive 1 4 6 10 6 0 2 7 11 4 4 1 22 2 5 Limited 10 Rare 15 Does no exist 20 25 No information Source: EMCDDA Annual Report 2009; expert rating on 26 EU MS + Norway and Turkey Conclusions • Drug use is major factor of imprisonment in Europe • Drug users represent a substantial proportion of the prison population • Health related problems, especially infectious diseases, more common among prisoners than among drug users in the community or in the general population • Drug related mortality is high, especially in the immediate period after prison release • Interventions for drug users in prison (drug treatment and health interventions) still not widely available in European prisons, but some European countries have several interventions options • Need to for more comparable European information on drug use and responses in prison • Monitoring and research should be improved at European level Thank you four your attention www.emcdda.europa.eu [email protected]